Dental Sleep Medicine Insider November DSM Insider | Page 28

BARRY GLASSMAN, DMD
TRUTH, MYTH, LORE, & MORE
O
cclusion is one of the most
potentially confusing and con-
troversial subjects in dentistry.
As a result, the occlusal chang-
es that can be associated with
oral appliance therapy become
confusing and controversial,
leading to fear, which tends to
prevent treatment, or at least
a concern that compromises
treatment.
Much has been written and
taught about the need to main-
tain an ideal occlusion in all of
dentistry. Creating or estab-
lishing an occlusion as close to
ideal has been taught as one of
the goals of therapy for every
patient in every dental school.
The goal of ideal occlusal
schemes remains standard in
dentistry until this very day de-
spite the predominance of the
literature that makes it clear
there is no direct relationship
between malocclusion and
pain or dysfunction. There has
never been any relationship
established between Angle’s
classification and pain or dys-
function, and myths that asso-
ciate deep bites with condylar
position and joint dysfunction
have been debunked.
Despite the science of occlu-
sion and pain and/or dysfunc-
tion and the fact that the vast
majority of patients have some
form of “malocclusion”, the
occlusal myths continue to be
taught.
It is therefore understandable
how disconcerting it would
be to a dentist to be respon-
sible for a treatment regimen
that has the potential to create
what would be considered a
malocclusion. We know that
a percentage of our patients
using oral appliance therapy
to treat their sleep disturbed
breathing may in fact develop,
among other possibilities, a
posterior open bite. If one isn’t
well trained in terms of masti-
cation, the inability to bring the
posterior teeth together may
make it seem as though this
would be problematic. Unfor-
tunately, not only are dentists
taught myths that continue to
be propagated about occlusion,
but we are not well trained in
the masticatory process. The
vast majority of patients who
develop posterior open bite ex-
perience no masticatory com-
promise, and are only aware of
DR. BARRY GLASSMAN, DMD
Barry Glassman maintains a
private practice in Allentown,
PA, which is limited to chronic
pain, temporomandibular joint
dysfunction and dental sleep
medicine. He is a Diplomate of
the Board of the Academy of
Dental Sleep Medicine. He is on
staff at the Lehigh Valley Hos-
pital Sleep Disorder Center.
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the occlusal changes when the
concerned dentist brings it to
their attention.
An honest, evidenced based
look at occlusion will help in
the management of the occlu-
sal changes with oral appliance
therapy and put occlusion in a
new perspective in your gen-
eral dental practice. This will
lead to an appropriate discus-
sion of risks and benefits of
oral appliance therapy so that
the risk/benefit quotient can
be accurately discussed with
patients to help you work with
your patients making intelli-
gent well-informed decisions.